Start Date: Interview Types
Skills Healthcare Effective.. Visa Types US Citizen
Job Title: HEDIS Data Analyst (SQL)
Location: Philadelphia ,PA - Hybrid - 3 Days a week in the office/ Remote
Duration: Long-Term Contract
Job Summary
We are seeking a detail-oriented HEDIS Data Analyst with strong
SQL skills to support
Healthcare Effectiveness Data and Information Set (HEDIS) reporting, quality improvement initiatives, and healthcare data analysis. The ideal candidate will have experience working with healthcare data, analyzing HEDIS measures, validating data accuracy, and developing SQL queries to support reporting, compliance, and performance improvement.
Key Responsibilities
- Analyze and validate HEDIS (Healthcare Effectiveness Data and Information Set) measures to support quality improvement and regulatory reporting.
- Develop, write, optimize, and maintain complex SQL queries for healthcare data extraction, validation, and reporting.
- Perform data analysis to identify trends, gaps in care, and opportunities for quality improvement.
- Validate data accuracy and ensure compliance with HEDIS specifications and organizational standards.
- Collaborate with quality, clinical, business, and IT teams to support HEDIS reporting initiatives.
- Perform data reconciliation, quality assurance, and root cause analysis of data discrepancies.
- Support annual HEDIS submission activities, including data validation and audit preparation.
- Create reports, dashboards, and data summaries to support leadership decision-making.
- Monitor data quality and recommend process improvements to improve reporting accuracy.
- Document SQL queries, data mapping, business rules, and reporting processes.
- Assist with troubleshooting data issues and resolving reporting discrepancies.
- Ensure compliance with HIPAA and healthcare data privacy regulations.
Required Qualifications
- Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, Data Analytics, or a related field (or equivalent experience).
- 3+ years of experience working with HEDIS reporting or healthcare quality data.
- Strong hands-on experience writing and optimizing SQL queries.
- Experience analyzing large healthcare datasets.
- Knowledge of HEDIS measures, quality reporting, and healthcare data standards.
- Strong analytical, problem-solving, and data validation skills.
- Excellent communication and documentation skills.
Preferred Qualifications
- Experience with managed care, health plans, or payer organizations.
- Familiarity with NCQA HEDIS specifications and reporting guidelines.
- Experience with healthcare data warehouses and reporting tools.
- Knowledge of claims, provider, member, and clinical data.
- Experience with ETL processes and data integration.
- Experience with BI tools such as Power BI, Tableau, or SSRS.
Required Skills
- HEDIS (Healthcare Effectiveness Data and Information Set)
- SQL
- Database Querying
- Healthcare Data Analysis
- Data Validation
- Data Quality
- Reporting & Analytics
- Healthcare Quality Measures
- Claims Data Analysis
- Clinical Data Analysis
- NCQA HEDIS Guidelines
- Data Reconciliation
- Root Cause Analysis
- Dashboard Development
- HIPAA Compliance
- Microsoft SQL Server / Oracle / PostgreSQL (as applicable)
- Problem Solving
- Documentation
- Healthcare Informatics
Quality Improvement